Mitapivat

Check back to this tracker for regulatory updates on marketed drugs, including expansions into new geographies and indications. Welcome to Fierce Pharma's regulatory tracker for the first half of 2025. On this page, we're recording the regulatory progress of in-market products, including expansions into key geographies and new indications. Be sure to come back regularly for the latest updates.UPDATED: Friday, March 14 at 9:25 a.m. ETChina's National Medical Products Administration (NMPA) has approved Innovent's Sycume as a treatment for thyroid eye disease (TED).The drug, also known as teprotumumab N01, becomes the first anti-insulin-like growth factor 1 receptor (IGF-1R) antibody to score approval in the country.In a press release, Innovent said the drug's approval "has ended a 70-year drought of no new treatment option for TED in China."In the U.S., teprotumumab is marketed by Amgen as Tepezza. In Europe, officials have expanded the label for Bristol Myers Squibb's cell therapy Breyanzi.Specifically, the European Commission approved the drug for the treatment of adult patients with relapsed or refractory follicular lymphoma (FL) after two or more lines of systemic therapy.The approval is based on results from the global phase 2 study called TRANSCEND FL, which enrolled patients with relapsed or refractory indolent non-Hodgkin lymphoma (NHL), including FL. In the third-line-plus treatment setting, 97.1% of patients responded to the drug, and 94.2% of patients achieved a complete response.Before this approval, Breyanzi had scored EU nods to treat certain patients with diffuse large B-cell lymphoma, high grade B-cell lymphoma and primary mediastinal large B-cell lymphoma.UPDATED: Thursday, March 13 at 8:30 a.m. ETKelun-Biotech's TROP 2 ADC sacituzumab tirumotecan (sac-TMT) has scored its second approval in China.The country's National Medical Products Administration (NMPA) approved the drug to treat certain adults with EGFR-positive locally advanced or metastatic non-squamous non-small cell lung cancer (NSCLC). The nod covers the drug's use in patients who have progressed after treatment with EGFR-tyrosine kinase inhibitor (TKI) therapy and platinum-based chemotherapy, Kelun said in a press release.With the approval, sac-TMT becomes the first TROP2 ADC approved to treat lung cancer anywhere in the world, according to the company.In a pivotal study, the drug "demonstrated a statistically significant and clinically meaningful improvement" in objective response rate, progression-free survival and overall survival compared with docetaxel, Kelun said. The study tested the drugs in patients with locally advanced or metastatic EGFR-mutant NSCLC who failed after prior treatment with an EGFR-TKI and platinum-based chemo.The approval is sac-TMT's second in the country after the NMPA approved it to treat certain patients with  triple negative breast cancer last year.In 2022, Merck & Co. licensed ex-China rights to the drug.UPDATED: Friday, March 7 at 9:35 a.m. ETThe European Commission (EC) has signed off on Bristol Myers Squibb’s immunotherapy combination of Opdivo and Yervoy to treat first-line patients with advanced or unresectable hepatocellular carcinoma (HCC).The nod was based on Opdivo and Yervoy showing an overall survival edge in the CheckMate-9DW trial over an investigator's choice of oral treatments.The Opdivo-Yervoy combo also faces an FDA decision date of April 21 to treat unresectable HCC. In 2020, the FDA granted accelerated approval to Opdivo-Yervoy to treat second-line advanced HCC.Opdivo and Yervoy were originally approved to treat melanoma, in 2014 and 2011 respectively. In combination, they have been blessed by the FDA in four other cancer types: renal cell carcinoma (2018), colorectal cancer (2018), mesothelioma (2020) and lung cancer (2020).Approximately 90% of liver cancer diagnoses are of the HCC type, BMS said. Liver cancer is the world’s third leading cause of cancer deaths.The FDA has expanded its approval for ALK’s immunotherapy Odactra for house dust mite (HDM) allergies to children ages 5 through 11. The under-the-tongue tablet was originally approved for adults in 2017 and then for adolescents ages 12 to 17 in 2023.UPDATED: Thursday, March 6 at 9:45 a.m. ETARS Pharmaceuticals needle-free epinephrine option, neffy nasal spray, can now be used to treat type 1 allergic reactions including anaphylaxis in children.To win the pediatric nod from the FDA, ARS ran studies proving that pharmacokinetic and pharmacodynamic responses from neffy in both children and adults were consistent with that of standard epinephrine injection products. The label expansion comes after the drug’s August approval as the first major innovation in epinephrine delivery in more than 35 years. Needle-free delivery is especially significant in the pediatric population as many children and caregivers fear needle-based auto-injectors, standing to delay lifesaving treatment.Human factor studies also show that children as young as 10 can use the nasal spray effectively and that untrained individuals, such as babysitters or teachers, can also correctly administer the drug. In the U.S., nearly 4 out of every 10 epinephrine prescriptions are for children under the age of 18 and some one in 13 children have severe food allergies, with more than 40% having experienced severe reactions, according to ARS. UPDATED: Wednesday, March 5 at 10:10 a.m. ETRoche's supplemental biologics application for Gazyva to treat lupus nephritis has been accepted for review by the FDA, the company said in a Wednesday press release.The filing leverages results from the phase 3 REGENCY study, which showed that 46.4% of patients with lupus nephritis who received Gazyva plus standard care achieved a complete renal response after 76 weeks. For patients who received standard care alone, the number was 33.1%, according to study results published last month.First approved in 2013, Gazyva is already cleared to treat chronic lymphocytic leukemia and follicular lymphoma in certain situations.The FDA is expected to make a decision on the lupus nephritis filing by October, according to Roche.UPDATED: Monday, March 3 at 4:30 p.m. ETDespite a reconsideration after a prior rejection, Australian drug regulators ultimately passed on Eisai's BioArtic-partnered Alzheimer’s disease treatment Leqembi. The Therapeutic Goods Administration (TGA) of Australia first decided against approval for patients with early Alzheimer’s disease in October. Eisai then requested reconsideration of the decision in December, proposing the same narrow indication given to the drug by the Medicines and Healthcare products Regulatory Agency (MHRA) and European Medicines Agency (EMA). Those approvals stipulate that Leqembi can only be used in patients with one or no copies of the ApoE4 gene due to safety concerns linking two copies of the gene to increased risks of brain swelling and bleeding, a side effect known as Amyloid Related Imaging Abnormalities (ARIAs).However, the TGA did not agree with the safety profile of Leqembi in ApoE4 heterozygotes, or those with one copy of the ApoE4 gene. Instead, the regulator offered an alternative narrow indication covering only ApoE4 noncarriers. Eisai floated other indications instead, including one that would keep the ApoE4 noncarrier and heterozygote patient populations but require heterozygotes to receive treatment in specialist centers with expert physician supervision. Still, the TGA rejected those options.BioArtic, Eisai’s long-time research partner that originally developed the antibody that became Leqembi, said it’s “very disappointed” by TGA’s decision, CEO Gunilla Osswald said in a statement. Eisai said it remains committed to ensuring eligible Australians can access the treatment and is “exploring options” to achieve this including a potential review by Australia’s Administrative Review Tribunal. UPDATED: Friday, Feb. 28 at 10:30 a.m. ETThe CDC said it's investigating five hospitalizations related to heart and nervous system events following vaccination with Valneva's Ixchiq among people 65 years and older. Ixchiq became the first FDA-approved chikungunya vaccine in November 2023. The CDC currently recommends the live-attenuated shot to be used for adults traveling to a country or territory where there is a chikungunya outbreak. Based on information from the CDC, at least four of the five individuals had also received other vaccines, and most of them had significant underlying medical conditions, a Valneva spokesperson said in a statement to Fierce Pharma."Valneva has not identified any safety signal concerns through post-marketing safety monitoring, including periodic safety reports and routine signal detection activities, and Ixchiq’s safety profile remains consistent with clinical trial data, unchanged and positive," the spokesperson said.The CDC said findings from its investigation will be discussed with experts at an Advisory Committee on Immunization Practices (ACIP) meeting. This year's first ACIP meeting, which was supposed to take place this week, was postponed with no new time provided by the CDC.The U.K. has approved Moderna's respiratory syncytial virus (RSV) vaccine mRESVIA to protect patients ages 60 and over against lower respiratory tract disease caused by the virus.In a study conducted in about 37,000 older adults, people who received mRESVIA had a 79% reduction in their risk of getting lower respiratory tract disease caused by RSV, compared with those who received placebo, around four months after vaccination.The shot will be manufactured at the Moderna Innovation and Technology Centre in Oxfordshire, which will be fully operational later this year, CEO Stéphane Bancel said in a statement.As is the case in the U.S., Moderna's mRNA shot will compete with GSK's Arexvy and Pfizer's Abrysvo in the U.K. as well.UPDATED: Thursday, Feb. 27 at 8:32 a.m. ETAfter being turned away by the FDA nearly one year ago, Regeneron this week said that the U.S. agency has accepted for review its biologics license application for bispecific antibody odronextamab.The FDA is expected to act on the application by July 30, Regeneron said in a Wednesday press release.In March of 2024, the agency rejected an accelerated approval filing for the drug based on the timeline of Regeneron's ongoing confirmatory trials. That decision spurred some confusion at Regeneron—and beyond—about a new requirement from the agency that confirmatory trials be "well underway" by the time it awards accelerated approvals.Early this year, the FDA sought to clear up the issue with new guidance on its expectations around accelerated approvals and confirmatory trial timelines.Nevertheless, Regeneron's review for the drug to treat patients with relapsed/refractory (R/R) follicular lymphoma (FL) after two or more lines of systemic therapy now appears back on track. In its latest press release, Regeneron said the resubmission "follows the achievement of an FDA-mandated enrollment target for the Phase 3 confirmatory trial." As the company notes, the enrollment target was the "sole approvability issue identified by the FDA" in its last submission.In Europe, regulators last year approved the drug for patients with R/R FL and R/R diffuse large B-cell lymphoma after two or more lines of systemic therapy. The medicine carries the brand name Ordspono in the region.In a phase 2 study, 80% of patients with FL who were treated with odronextamab responded to the therapy, with 74% achieving a complete response.UPDATED: Tuesday, Feb. 25 at 9:30 a.m. ETMerck's Keytruda, already boasting some 40 FDA approvals, has picked up a priority review in a proposed new use.The company's filing for the drug as part of a perioperative regimen for patients with resectable locally advanced head and neck squamous cell carcinoma has been accepted for a speedy review, Merck said on Tuesday.The filing seeks approval for Keytruda as a neoadjuvant treatment prior to surgery, followed by its administration as an adjuvant treatment in combination with standard of care radiotherapy—with or without cisplatin—after surgery. Afterward, the company's filing proposes Keytruda being used as a single agent.Merck's application leverages results from the KEYNOTE-689 trial, which showed that the perioperative regimen significantly reduced the risk of disease recurrence, worsening or death in certain patients with resected HNSCC compared with traditional postsurgical radiotherapy alone.The FDA is expected to act on the application by June 23.In Japan, Sanofi's Sarclisa has picked up an approval to treat newly diagnosed patients with multiple myeloma.Japan's Ministry of Health, Labour and Welfare (MHLW) approved the drug as part of a combination with bortezomib, lenalidomide, and dexamethasone (VRd) in the patient group based on results from the phase 3 IMROZ trial. The study showed that Sarclisa's addition to VRd significantly improved progression-free survival compared with VRd alone in patients with newly diagnosed, transplant-ineligible multiple myeloma.Sarclisa launched in 2020 in Japan and is approved as a part of four different regimens in the country, Sanofi noted in a press release.UPDATED: Monday, Feb. 24 at 10:52 a.m. ETGilead's application for twice-yearly lenacapavir has been accepted by the European Medicines Agency for accelerated review as an HIV pre-exposure prophylaxis (PrEP) option. Simultaneously, the drug will be assessed under EU-Medicines for all, which can be used to facilitate expedited review processes in countries outside the EU, including in low- and lower-middle-income countries. The FDA has put lenacapavir's PrEP application under priority review last week with a target decision date set for June 19, 2025.Several companies have launched their biosimilar products referencing Johnson & Johnson's star inflammatory disease drug Stelara in the U.S., following Amgen's January launch of Wezlana as the first biosimilar referencing the star IL-12/23 inhibitor. Teva and Alvotech just rolled out Selarsdi covering all indications and presentations of the original Stelara. Teva can start to claim interchangeability after an exclusivity period for Wezlana ends on April 30. Sandoz announced the launch of its Samsung Bioepis-partnered Pyzchiva, which the Swiss company views as a key driver in its global growth strategy. Sandoz touts Pyzchiva's extended stability, including the ability to be re-refrigerate, as an advantage over the original Stelara.In addition, Biocon Biologics has also entered the U.S. Stelara biosimilar market with Yesintek. It marks the Biocon subsidiary's "first product launch in the United States since becoming a fully integrated global biosimilars organization," CEO Shreehas Tambe said in a release. The FDA has granted priority review to Bristol Myers Squibb's application for Opdivo and Yervoy in first-line unresectable or metastatic microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR) colorectal cancer (mCRC). The goal date is June 23, 2025.The filing was based on data from the phase 3 CheckMate-8HW trial. The combo lowered the risk of disease progression or death by 38% versus Opdivo alone in MSI-H/dMMR mCRC, according to an update of the study presented in January.The FDA has updated the label of Indivior's Sublocade for severe opioid use disorder. The new label allows healthcare providers to start treatment with Sublocade after a single dose of transmucosal buprenorphine and a one-hour observation period. This rapid initiation "may lessen some of the practical obstacles to treatment induction," according to Indivior.In addition, the FDA has approved additional injection sites for Sublocade, an extended-release formulation of buprenorphine. The drug can now be administered in the abdomen, thigh, buttock or back of the upper arm.UPDATED: Friday, Feb. 21 at 9:30 a.m. ETGilead's seladelpar has secured a conditional marketing nod in Europe to treat adults with primary biliary cholangitis (PBC).The approval covers seladelpar's use in combination with ursodeoxycholic acid (UDCA) for those who have an inadequate response to UDCA alone, or as a monotherapy for people who can't tolerate UDCA.In the U.S., seladelpar picked up FDA approval last year and is branded as Livdelzi.A chronic autoimmune disease, PCB affects roughly 22 out of 100,000 people in Europe. The disease is more common in women and causes liver damage that can progress to liver failure if untreated. Symptoms include chronic itch and fatigue, and there is no cure for the disease.The approval is largely based on results from the phase 3 Response study, which showed that roughly three times as many patients on seladelpar achieved a composite biochemical response than those on placebo. The conditional approval will be contingent on positive results from future confirmatory studies.In Japan, authorities have approved CSL's subcutaneous Andembry for the prevention of acute attacks of hereditary angioedema (HAE).The drug offers patients the first pre-filled pen presentation for monthly subcutaneous administration for long-term prophylaxis of HAE, CSL said in a press release.The Japanese nod adds to the drug's other approvals in Europe, Australia and the U.K.UPDATED: Thursday, Feb. 20 at 10:00 a.m. ETBristol Myers Squibb's Breyanzi has won reimbursement backing from England's National Institute for Health and Care Excellence (NICE) in second-line large B-cell lymphoma, becoming the first CAR-T therapy to be recommended by the agency for this cancer type. The endorsement comes after NICE had originally rejected Breyanzi in October 2024 during its draft assessment. The drug cost watchdog changed its mind after BMS "offered an improved commercial arrangement" to the NHS based on its 297,000 pound sterling (about $375,000) list price per person, according to a press release.About 600 people in England could benefit from the therapy per year, according to NICE, which called the one-time CAR-T treatment "a significant advance in lymphoma care." In another reversal, NICE has also changed a previous rejection and signed off on UCB's Fintepla as an add-on treatment for seizures associated with Lennox-Gastaut syndrome (LGS) in people ages 2 years and above. The drug already has coverage under NHS for treating seizures from Dravet syndrome.LGS is a rare but severely debilitating form of epilepsy that begins in early childhood. By NICE's estimate, about 1,400 patients live with the disease in its jurisdiction.NICE changed its mind after UCB offered "an improved discount" to the drug's list price, the agency noted. Using a cost comparison approach, UCB convinced NICE's drug reviewers that Fintepla provides similar or greater health benefits compared to cannabidiol plus clobazam—which is already covered for LGS in the NHS—at a similar or lower cost.  The drug is covered only if the frequency of drop seizures is checked every six months, at which point the frequency is reduced by at least 30% compared with before starting treatment. UPDATED: Tuesday, Feb. 18 at 11:04 a.m. ETMerck’s Welireg snagged its first two approvals in Europe, with the nods covering certain patients with von Hippel-Lidau (VHL) disease and advanced clear renal cell carcinoma (RCC).The European Commission specifically approved the medicine as a treatment for those with VHL disease who have associated, localized RCC, central nervous system hemangioblastomas or pancreatic neuroendocrine tumors. The drug is approved in cases when localized procedures are unsuitable, making Welireg the first available treatment for VHL-associated tumors in Europe. The med also won a nod for adult patients with advanced clear cell RCC that has progressed following two or more lines of therapy, including a PD-1/L1 and at least two VEGF-targeted therapies.The European nods, which are conditional authorizations, follow similar approvals in the U.S. Merck will make the drug commercially available individual European countries after the complication of national reimbursement procedures, among other launch timing factors, the company said.Gilead’s twice-yearly pre-exposure prophylaxis (PrEP) candidate lenacapavir is on the FDA’s review table with a decision date of June 19.The drug, which is currently approved as Sunlenca for multi-drug resistant HIV, would be the first twice-yearly PrEP option on the market. The company’s FDA bid is the first step of its detailed global launch and access strategy.Gilead’s lenacapivir application is backed by two phase 3 trials, one of which showed an impressive 100% risk reduction. The company describes the med as a “foundation” for potential future HIV therapies, it said in a release.Sanofi and Regeneron’s immunology powerhouse Dupixent is aiming to secure a new use in chronic skin disease bullous pemphigoid (BP) with an FDA decision expected by June 20.If approved, the med would be the only targeted BP treatment available in the U.S. The disease is hallmarked by intense itch and blisters and impacts a population of around 27,000 adults, typically elderly adults, whose condition is not controlled by systemic corticosteroids.  The companies’ FDA bid has been granted priority review and is based on a study of 106 adults with moderate-to-severe BP. In the trial, five times more patients who received Dupixent achieved sustained disease remission compared to those on placebo, according to Sanofi. UPDATED: Friday, Feb. 14 at 9:20 a.m. ETCSL's hereditary angioedema (HAE) therapy Andembry has secured approval from the European Commission.The drug is the first once-monthly treatment targeting factor XIIa to prevent HAE attacks in patients 12 and older. In a phase 3 trial, the drug significantly reduced investigator-confirmed HAE attacks per month versus placebo, according to results published in The Lancet in April 2023.Last month, regulators in Australia and the U.K. signed off on the medicine."Andembry, CSL's first approved recombinant monoclonal antibody discovered and developed entirely by CSL, underscores our more than 40-year legacy in HAE research and treatment optimization and our decades-long journey to bring this innovation to patients," Bill Mezzanotte, M.D., CSL's head of R&D, said in a press release.Now, CSL plans to engage in access and reimbursement negotiations with national authorities across Europe as the company progresses with the rollout.Also in Europe, officials signed off on CSL and Arcturus Therapeutics' self-amplifying mRNA COVID-19 vaccine, Kostaive, for use in individuals ages 18 and older.The approval is based on results from an integrated phase 1/2/3 study and late-stage booster trials, the partners said in a press release. Late last year, the European Medicines Agency recommended the vaccine for approval.Besides Europe, the vaccine is approved in Japan.Galderma's efforts to expand the market for Nemluvio are bearing more fruit.In Europe, officials approved the subcutaneous drug for the treatment of moderate-to-severe atopic dermatitis in patients ages 12 and older. In addition, the drug scored an endorsement to treat prurigo nodularis in adults.In the late-stage Arcadia and Olympia clinical trial programs, the drug "significantly improved itch, skin lesions and sleep disturbance, in patients with moderate-to-severe atopic dermatitis and adults with prurigo nodularis, respectively," Galderma said in a Friday press release.The drug is also approved in the U.S. and is under review in Canada, Brazil, South Korea and other countries.China has approved its 22nd PD-1/L1 product. The approval went to SinoCellTech's finotonlimab for its use alongside chemo in first-line head and neck cancer. In a China phase 3 trial, the combo reduced the risk of death by 27% versus chemo alone, extending the median overall survival by 3.6 months to 14.1 months, according to results published in Nature Medicine.The go-ahead marks the first for a PD-1/L1 inhibitor that covers all head and neck cancer patients in China. In the country, Merck & Co.'s Keytruda is allowed as a monotherapy only in PD-L1-positive disease, SinoCellTech noted in a securities filing (Chinese). UPDATED: Wednesday, Feb. 12 at 10:20 a.m. ETAcoramidis, the transthyretin amyloid cardiomyopathy (ATTR-CM) drug developed by BridgeBio and licensed by Bayer in Europe, has been approved by the European Commission. Bayer plans to make the transthyretin stabilizer available in Europe under the brand name Beyonttra in the first half of this year.The approval is based on results from the phase 3 ATTRibute-CM study trial showing that Beyonttra significantly reduced the composite endpoint of all-cause mortality and cardiovascular-related hospitalizations compared with placebo. During the open-label extension phase of the study, Beyonttra demonstrated a relative risk reduction in deaths of 34% after 42 months.Beyonttra's launch is one of Bayer's “must-win battles” as the German company navigates the loss of exclusivity of its top-selling drug, blood thinner Xarelto, Stefan Oelrich, head of Bayer’s pharma division, said at the J.P. Morgan Healthcare Conference in January.Travere Therapeutics said it has aligned with the FDA on its plan to submit Filspari for traditional approval in focal segmental glomerulosclerosis (FSGS), a rare kidney disease. The move comes after a Filspari phase 3 trial in that indication failed on its primary endpoint of eGFR slope, a measurement of kidney disease progression. It also comes as findings from a collaborative global project called ARASOL linked a decrease in proteinuria over 24 months to a reduction in the risk of kidney failure in FSGS. Filspari has shown a benefit in lowering proteinuria. Travere plans to file this application around the end of March using existing data from the phase 3 DUPLEX and phase 2 DUET studies. The company will request a priority review, which Leerink Partners analysts believe is likely to be granted as there are no approved therapies for FSGS. Given that the understanding around proteinuria as a potential full approval endpoint is new, Leerink analysts said it would not be surprising if the FDA wanted to discuss the results during an advisory committee meeting.An approval in FSGS would be "transformational" for Filspari and Travere, Leerink said in a Tuesday note, because it could give the drug $1.1 billion in peak sales across the U.S. and EU based on a "relatively conservative peak penetration" of less than 20%. For Filspari sales, the FSGS indication could eventually surpass IgA nephropathy, for which Filspari is currently approved and is starting to face more competition, according to Leerink Partners.UPDATED: Monday, Feb. 10 at 9:45 a.m. ETBristol Myers Squibb’s cancer combo Opdivo plus Yervoy has scored an approval recommendation in the E.U., thanks to an endorsement from the EMA’s Committee for Medicinal Products for Human Use (CHMP) as a first-line treatment in adults with unresectable or advanced hepatocellular carcinoma.With the thumbs up from CHMP, the Opvido-Yervoy combo now moves forward to the European Commission (EC) for a final approval decision.The CHMP based its green light on results from the combo’s phase 3 CheckMate -9DW trial, in which patients on Opdivo and Yervoy charted a median overall survival of 23.7 months, compared to 20.6 months in patients who received an alternative regimen of Lenvima (lenvatinib) or sorafenib.BMS’ cancer combo is up for a similar approval in the U.S., with the FDA scheduled to make its decision on a potential first-line unresectable HCC nod by April 21.The drugmaker also won a CHMP endorsement for its CAR-T therapy Breyanzi to treat adults with relapsed or refractory follicular lymphoma (FL) who’ve previously tried two or more systemic therapies.BMS used data from its phase 2 TRANSCEND FL study to support the recommendation. In the trial, Breyanzi charted an overall response rate of 97.1% and a complete response rate of 94.2%, which was sufficient to meet the study’s primary and secondary endpoints, BMS said in a release.Breyanzi already carries multiple oncology approvals in Europe, including in relapsed or refractory diffuse large B-cell lymphoma and high grade B-cell lymphoma.Late last month, the FDA gave a thumbs up to German drugmaker medac’s alkylating agent Grafapex, also known as treosulfan, alongside the antimetabolite medicine fludarabine, as a preparative regimen for allogeneic hematopoietic stem cell transplantation (alloHSCT) in adults and kids ages one and older with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS).Alkylating agents cause breakage of DNA strand to help thwart the ability of cancer cells to multiply.Medac’s approval was backed up by a study looking primarily at overall survival in 570 adults ages 18 to 70 years old with AML or MDS who were randomized to receive either Grafapex or busulfan with fludarabine as a preparative regimen for allogeneic transplant. UPDATED: Wednesday, Feb. 5 at 9:05 a.m. ETNovartis' Kisqali has secured a label expansion from the U.K.'s Medicines and Healthcare products Regulatory Agency (MHRA).The new approval covers Kisqali's use in combination with an aromatase inhibitor (AI) in patients with HR+/HER2- early breast cancer at high risk of recurrence. Previously, the drug was approved by the MHRA to treat advanced breast cancer, according to a Feb. 4 press release from Novartis.The latest approval is based on results from the phase 3 NATALEE trial, which showed that the addition of Kisqali to treatment with an AI cut the risk of invasive disease, recurrence, or death compared to AI treatment alone in patients with HR+/HER2- early breast cancer.Last fall, the drug picked up an FDA nod in patients with HR+/HER2- early breast cancer based on the NATALEE study results.Vaccine specialist Valneva has picked up an approval from the MHRA, as well.The agency approved the company's chikungunya vaccine, Ixchiq, for use in people 18 years of age and older. Late-stage trial data show the vaccine "induces a rapid and strong immune response," according to a press release from the company.Valneva manufactures the shot at its facility in Livingston, Scotland.Previously, the vaccine secured approvals in the United States, Canada and Europe. UPDATED: Friday, Jan. 31 at 9:35 a.m. ETVertex's groundbreaking launch of Casgevy keeps racking up more milestones around the globe.Friday, the company said it has reached a reimbursement agreement with NHS England that'll allow eligible patients with sickle cell disease access to the CRISPR/Cas9 gene-edited therapy. Along with the NHS England agreement, the National Institute for Health and Care Excellence (NICE) has signed off on the drug's use, Vertex said in a press release.The reimbursement deal follows a similar agreement, unveiled last summer, for the drug in patients with transfusion-dependent beta thalassemia.“We are pleased to have reached this new agreement that ensures both eligible SCD and TDT patients can now be treated with Casgevy, recognizing the value a one-time treatment can provide to patients, their families and the healthcare system," Vertex International senior vice president Ludovic Fenaux said in a statement.In its approval bid for Fabhalta in C3 glomerulopathy, Novartis will no longer face an FDA advisory committee meeting, CEO Vas Narasimhan said on Friday.The advisory committee meeting had been scheduled for next month but will no longer take place.Speaking with members of the media on Friday, Narasimhan said the "FDA no longer deemed it necessary to hold an advisory committee meeting.""We think it's based on, you know, the overall data package we've been able to generate, and the additional follow on data that we've provided the agency," the CEO continued. So we look forward to now bringing forward that medicine as a third indication approval for Fabhalta."Amid Europe's ongoing regulatory review of Eisai and Biogen's Alzheimer's disease medicine Leqembi, the European Commission (EC) has flagged new safety information for review.In November, Europe's Committee for Medicinal Products for Human Use (CHMP) recommended market approval of the drug. Since then, EC has asked the committee to "consider information on the safety of lecanemab that became available after the adoption of the CHMP opinion," the partners said in a Friday press release. The companies didn't reveal the nature of the new safety information flagged by the EC. CHMP will dig into the new info during a meeting next month, according to the release."We believe that the EC’s requests can be addressed with existing information and will be evaluated by the CHMP because of the clear and sufficient information available," the partners said in the release. "We will continue to work closely with the authorities toward approval in the EU."UPDATED: Monday, Jan. 27 at 10:43 a.m. ETMerck’s Welireg is up for a potential FDA label expansion by May 26. The agency granted a priority review to the company's bid to expand the drug's label into advanced, unresectable, or metastatic pheochromocytoma and paraganglioma (PPGL), which would add to currently approved indications in advanced renal cell carcinoma and von Hippel-Lindau disease.Welireg generated $139 million in sales during 2024’s third quarter and is the only approved HIF-2α inhibitor in the U.S.Merck’s application in PPGL is based on objective response rate and duration of response rate data from the phase 2 LITESPARK-015 trial, which enrolled 322 patients and will be presented at an upcoming medical meeting, according to the company. Up to 2,000 new cases of the tumors are diagnosed yearly in the U.S.Merck is evaluating Welireg across other rare oncologic diseases both on its own and in combination with other therapies. The FDA is evaluating Alvotech and Teva’s proposed biosimilar to Johnson & Johnson’s Simponi and Simponi Aria.Alvotech, which is responsible for development and manufacturing under its longstanding collaboration with Teva, announced positive top line results from its confirmatory trial of the Simponi copycat back in April. The partners expect the FDA to complete its review process in the fourth quarter of 2025. Simponi was first approved in 2009 and treats a variety of inflammatory conditions including rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis, among others. Simponi is an injected drug, while Simponi Aria is the infused version. The franchise picked up $2.19 billion for J&J in 2023 sales.Alvotech and Teva's product is the first biosimilar to the blockbuster arthritis med to be accepted for review.UPDATED: Thursday, Jan. 23 at 10:00 a.m. ETBiogen said its applications for a high-dose version of the spinal muscular atrophy med Spinraza have been accepted for review by the FDA and the European Medicines Agency. The new regimen comprises a more rapid loading regimen of two 50 mg doses given two weeks apart and a maintenance regimen given at 28 mg every four months. Currently, the drug's FDA-approved loading regimen features three doses given 14 days apart, plus a fourth dose 30 days after the third. The drug is currently approved in 12 mg doses.The high-dose applications are based on results from the phase 2/3 Devote trial, which favored the high-dose version versus an external sham control and the currently available dose on the measure of patients' reduction in plasma neurofilament light chain (NfL), a marker for neurodegeneration.The higher dose regimen also reduced the risk of death or permanent ventilation by 68% relative to sham and 30% compared with the 12 mg regimen.The high-dose Spinraza is Biogen's answer to competitors such as Novartis' gene therapy Zolgensma.Amneal has won FDA approvals for generics referencing AbbVie's Alzheimer's combo drug Namzaric and Novartis' cancer therapy Afinitor Disperz. Amneal has launched the Namzaric generic with 180-day market exclusivity.Separately, Amneal said it has won tentative approval from the FDA for a generic to Bausch Health's star irritable bowel syndrome med Xifaxan. Bausch Health has previously reached settlement agreements with Teva, Sun Pharma and Sandoz, pushing their generic entry dates into 2028 or upon an earlier launch of a rival generic product. Xifaxan is one of 15 drugs up for the second cycle of Medicare price negotiations under the Inflation Reduction Act. UPDATED: Tuesday, Jan. 21 at 8:57 a.m. ETThe European Commission has approved Johnson & Johnson's combination of Lazcluze and Rybrevant for the first-line treatment of certain adults with advanced non-small cell lung cancer (NSCLC), the company said in a press release.Specifically, the combo is approved in Europe for patients with epidermal growth factor receptor (EGFR) exon 19 deletions (ex19del) or exon 21 L858R (L858R) substitution mutations.In approving the use, EU regulators reviewed results from the phase 3 MARIPOSA study. The trial showed that the combination reduced the risk of disease progression or death by 30% compared with AstraZeneca's Tagrisso in patients with newly diagnosed, EGFR-mutant non-small cell lung cancer. The results yielded a U.S. approval for the J&J combination last summer. Earlier this month, J&J touted an overall survival win from the study. At the time, a company executive heralded the regimen as "a new standard of care for patients with EGFR non-small cell lung cancer."Also in Europe, officials have endorsed GSK's Jemperli to treat all adult patients with primary advanced or recurrent endometrial cancer, including those with mismatch repair proficient (MMRp)/microsatellite stable (MSS) tumors. MMRp and MSS cases represent approximately 75% of patients diagnosed with endometrial cancer, GSK said in a press release.The approval covers Jemperli's use in combination with chemotherapy.Late last year, Europe's Committee for Medicinal Products for Human Use (CHMP) recommended the label expansion.In England, the National Institute for Health and Care Excellence (NICE) recommended AstraZeneca's Tagrisso for treating people with EGFR mutation-positive non-small-cell lung cancer (NSCLC) after surgery.The recommendation means that hundreds of patients will benefit from routine access to the drug, which is taken daily alongside chemotherapy, according to a notice from the Roy Castle Lung Cancer Foundation.Previously, EGFR mutation-positive NSCLC patients relied on chemotherapy to prevent cancer recurrence after surgery, according to the foundation.“I am pleased we have been able to recommend that this targeted treatment for a specific gene mutation of lung cancer will be routinely available on the NHS," NICE's director of medicines evaluation, Helen Knight, said in a statement.UPDATED: Thursday, Jan. 16 at 10:25 a.m. ETEli Lilly's Omvoh has picked up its second major FDA nod. After the IL-23 inhibitor's approval in 2023 to treat ulcerative colitis, the agency has now signed off on Omvoh to treat Crohn's disease. Specifically, the FDA approved Omvoh to treat moderately to severely active Crohn's disease in adults.In a phase 3 study, 53% of patients treated with Omvoh achieved clinical remission after a year of treatment. That number compared with 36% for those on placebo.In addition, 46% of patients treated with Omvoh had visible healing of the intestinal lining after a year. In the placebo group, the number was 23%.The trial enrolled patients with moderately to severely active Crohn's disease who had experienced an inadequate response, loss of response or who could not tolerate corticosteroids, immunomodulators and/or biologics.With the FDA nod, Lilly's drug will go up against some heavy hitters in the Crohn's space, including Johnson & Johnson's Stelara and AbbVie's duo of Skyrizi and Rinvoq.UPDATED: Wednesday, Jan. 15 at 8:12 a.m. ETSanofi's Sarclisa has gained approval from China's National Medical Products Administration (NMPA) to treat adults with multiple myeloma who've received at least one prior line of therapy, including lenalidomide and a proteasome inhibitor.The approval covers Sarclisa's use in combination with pomalidomide and dexamethasone (Pd).Regulators in China endorsed the drug based on results from the phase 3 ICARIA-MM study, as well as bridging data from a China-based study, Sanofi said in a press release. In ICARIA-MM, the addition of Sarclisa to Pd resulted in a 40% reduction in patients' risk of disease progression or death. "We look forward to continuing to build strong partnerships with the medical community, local companies, and authorities in China as we work to bring more innovative treatments to patients," Sanofi's head of oncology, Olivier Nataf, said in a statement.As Biogen and Eisai work to grow Leqembi in Alzheimer's disease, the FDA has accepted a biologics license application for the drug's subcutaneous maintenance dosing option. With a potential approval, Leqembi would become the first anti-amyloid therapy to offer at-home maintenance dosing.The FDA is set to make a decision on the filing by August 31, according to a Biogen press release.UPDATED: Thursday, Jan. 9 at 11:15 a.m. ETEngland’s National Institute for Health and Care Excellence (NICE) recommended AstraZeneca’s Lynparza for use in the region’s National Health Service, clearing the way for around 1,200 eligible patients to reap the benefits of the treatment.The recommendation covers Lynparza’s use in patients with HER2-negative, locally advanced or metastatic breast cancer who have BRCA1 or BRCA2 mutations and have had chemotherapy. NICE based its decision in part on results from the company’s OlympiAD phase 3 study, which proved that the drug could cut the risk of disease worsening or death by 42%.NICE had originally begun its assessment of the treatment in that indication in 2018, but ended it citing a lack of evidence submitted by the company. This time around, NICE assessed the med using a faster cost comparison process that compared Lynparza to Pfizer’s Talzenna in benefits and cost. Stallergenes Greer’s peanut allergy treatment Palforzia scored a label expansion in Europe, extending the drug’s use to toddlers aged 1 through 3 years old.Palforzia is now cleared for use in those aged 1 to 17 years old and is the only approved oral immunotherapy in the U.S. and Europe for toddlers with a confirmed peanut allergy diagnosis. The drug is meant to gradually increase the body’s ability to tolerate small amounts of peanuts through carefully controlled initial dose escalation and up-dosing.The European Commission based its nod on the company’s POSEIDON phase 3 study, which was a double-blind, placebo-controlled food challenge after six months of treatment. Agios Pharmaceuticals’ Pyrukynd is up for an FDA decision in non-transfusion-dependent and transfusion-dependent alpha- or beta-thalassemia on Sept. 7.The company filed its bid for approval last month after finding success in two phase 3 trials assessing the drug in the non-transfusion-dependent and transfusion-dependent populations. Thalassemia is a rare, inherited blood disorder with limited treatment options. The disease is hallmarked by the abnormal production of hemoglobin, which causes chronic anemia and can lead to other complications.Pyruknd won its first approval in 2022 for pyruvate kinase (PK) deficiency, marking the first drug approved to treat the disease. Merck’s Gardasil HPV vaccine won approval from the National Medical Products Administration of China for males aged 9 to 26 years old, making the first option of its kind available for the country's male population.The vaccine was previously approved for use in females who are 9 to 45 years of age and has helped protect over 50 million women in China from certain HPV-related cancers and diseases since its first approval, Merck’s president of Human Health International, Joseph Romanelli, said in a release.Gardasil has recently seen slumping sales in China, where it's being marketed by Merck’s regional commercial partner Zhifei Biological Products. Rob David previously called the expansion to the male population a “significant opportunity.” UPDATED: Tuesday, Jan. 7 at 3:57 p.m. ETThe FDA tacked on additional warning information to the prescribing information for Agios’ pyruvate kinase (PK) deficiency drug Pyrukynd, flagging instances of liver deficiency in certain situations.The label update follows liver injury observations in patients who received Pyrukynd at a dose higher than is recommended for PK deficiency, according to an SEC filing from the company.The drug was approved by the FDA in 2022 as the first medicine to treat hemolytic anemia in adults with PK deficiency. Besides this use, the company is exploring expansions into beta thalassemia and sickle cell disease.The updated "Warnings and Precautions" section urges prescribers to run liver tests on patients before initiating treatment and monthly for the first six months of treatment. Patients should stop treatment if hepatic injury is suspected.Bayer is vying for a third indication for its Nubeqa (darolutamide) in China, this time for its use in combination with androgen deprivation therapy (ADT) in patients with metastatic hormone-sensitive prostate cancer.The company filed an application for the label expansion with China’s National Medical Products Administration, leveraging data from its phase 3 ARANOTE trial. In the study, Nubeqa and ADT significantly reduced the risk of radiological progression or death by 46% compared with placebo plus ADT.The nod would add to the drug’s two existing approvals in China, which cover other prostate cancer patient populations. It is estimated that the prevalence of prostate cancer in China will exceed 161,000 cases annually by 2026, according to Bayer. Dizal’s non-small cell lung cancer (NSCLC) candidate sunvozertinib will get a speedy FDA review after the agency granted priority review to the company’s new drug application.The company is specifically going after an approval to treat locally advanced or metastatic non-small cell lung cancer (NSCLC) in patients with epidermal growth factor receptor (EGFR) exon 20 insertion mutations whose disease has progressed on or after platinum-based chemotherapy. Sunvozertinib won its world-first approval in China in 2023. UPDATED: Monday, Jan. 6 at 10:25 a.m. ETAmgen's DLL3-targeted bispecific antibody Imdylltra, known as Imdelltra in the U.S., has won a conditional marketing authorization from the U.K.'s Medicines and Healthcare products Regulatory Agency as a third-line therapy for small cell lung cancer.The conditional nod is based on results from the phase 2 DeLLphi-301 trial, which showed that the T-cell engager triggered a tumor response rate of 41%, with the median response lasting 9.7 months. It follows an FDA approval in May 2024.China has approved Astellas' first-in-class Claudin 18.2 drug Vyloy, following similar moves by drug regulators in Japan and the U.S.The drug's Chinese indication is in first-line, CLDN18.2-positive, HER2-negative advanced gastric or gastroesophageal junction adenocarcinoma. The CLDN18.2 biomarker is expressed by about 35% of Chinese stomach cancer patients, according to Astellas.The approval was backed by two global phase 3 trials, dubbed Glow and Spotlight, which evaluated Vyloy in combination with the chemotherapy regimens CAPOX and mFOLFOX6, respectively. Both trials linked the drug's chemo combo to longer life expectancy and progression-free survival time compared with chemo alone.UPDATED: Friday, Jan. 3 at 2:45 p.m. ETGSK’s IL-5 inhibitor Nucala scored a nod in China to treat people with inadequately controlled chronic rhinosinusitis with nasal polyps (CRSwNP), a condition that impacts nearly 30 million people in China.The drug was approved by China’s National Medical Products Administration for use as an add-on therapy along with intranasal corticosteroids for patients with CRSwNP who don’t achieve adequate disease control with systemic corticosteroids or surgery. The indication is Nucala’s third in China and comes after prior approvals in eosinophilic asthma and eosinophilic granulomatosis with polyangiitis.An FDA advisory committee panel is scheduled to discuss the merits of Novartis’ oral factor B inhibitor Fabhalta in the rare kidney disease C3 glomerulopathy (C3G).The Cardiovascular and Renal Drugs Advisory Committee will meet on February 24, according to an FDA document (PDF). The drug was approved by the agency in 2023 as a treatment for paroxysmal nocturnal hemoglobinuria, winning the title of the first oral monotherapy approved for the rare blood disorder. Fabhalta received a second nod for immunoglobulin A nephropathy (IgAN) in August.In studies, Fabhalta proved that it could reduce proteinuria for C3G patients, a marker for delaying progression to kidney failure. So far, there are no approved treatments for the ultra-rare disease, which causes about 50% of patients to progress to kidney failure within ten years of diagnosis. UPDATED: Thursday, Jan. 2 at 1:45 p.m. ETShortly before the new year, Merck & Co. scored an approval for its potential blockbuster Winrevair in the U.K. The pulmonary arterial hypertension (PAH) drug, which also goes by the name sotatercept, was originally picked up via Merck’s $11.5 billion acquisition of Acceleron back in 2021.The U.K.’s Medicines and Healthcare products Regulatory Agency (MHRA) approved Winrevair in combination with other PAH therapies to improve exercise capacity in adult patients who live with moderate or marked limitations of physical activity.Patients with PAH suffer from high blood pressure in the blood vessels that supply the lungs, which can ultimately damage the right side of the heart. Winrevair, for its part, targets the causes of PAH responsible for the narrowing of the arteries in the lungs, in turn making it easier for the heart to pump blood to the pair of organs, according to the U.K. government’s release.The MHRA based its approval on a study of 323 PAH patients that saw Winrevair best placebo at improving exercise ability. The main measure of effectiveness in the trial was the difference in distance patients could walk in six minutes before and after treatment.At the trial’s 24-week treatment mark, patients on Winrevair plus other PAH medicines improved their walking distance by around 34 meters, versus one meter in patients who received placebo.Merck’s U.K. nod for Winrevair follows green lights from the U.S. FDA last March and the European Commission in August.At the time of the drug’s U.S. approval last year, J.P. Morgan’s Chris Schott estimated Winrevair could eventually reel in peak sales between $3 billion and $4 billion. 

聚焦新药 早研早聊 学以致用  侃侃而言 DOI:  10.1021/acs.jmedchem.3c02374 2022年，共有23个新的小分子化学实体（NCEs）获得美国FDA、欧盟EMA、日本PMDA、和中国NMPA批准为药物。 2024年3月15日，辉瑞联合默沙东、武田制药在J. Med. Chem.上发文，分析汇总了基于专利、和主要文献的以上新药大规模合成方法。 01 2022年获批小分子新药总览 2022年，共有23个新的小分子化学实体获批为药物，除此之外，本文还包括了于2021、2020年获批的11种药物，在此前的系列年度综述中没有提及，在此一同汇总。 因此，本文共汇总了34种药物的大规模合成方法，以及它们的治疗应用和作用机制。其中，从治疗领域的角度来看： 有5种药物用于抗感染，包括抗病毒、抗细菌、抗真菌； 有4种药物用于心血管和血液领域； 有4种药物用于中枢神经系统疾病； 有3种药物用于免疫疾病； 有2种代谢药物； 有15种肿瘤领域药物（包括诊断和治疗药物）； 有1种呼吸及肺部药物。 具体药物结构如下图： 02 抗感染/抗生素药物 2.1、Azvudine (1) Azvudine(1)是中国真实生物技术公司生产的抗病毒药物。它于2021年在中国获得批准，成为治疗人类免疫缺陷病毒（HIV）的首创新药。它具有双重功能，作为抗转录酶抑制剂，靶向病毒感染因子/载脂蛋白B mRNA编辑酶，催化亚单位3G(Vif/A3G）蛋白-蛋白相互作用。 2022年，该药物在中国被重新批准，用于治疗Covid-19。其作为RNA依赖性RNA聚合酶（RdRp）抑制剂，机制与先前批准的莫硝帕韦和瑞德西韦相同。除抗病毒活性外，胸腺内的药物浓度表明其具有免疫靶向活性；这种双重功能在RdRp抑制剂中独一无二。 其百克级合成路线如下： 2.2、Lenacapavir (Sunlenca) Lenacapavir（2）于2022年首次在欧盟获得批准，与其他抗逆转录病毒药物联合使用，用于患有多药耐药HIV感染的成年人，否则无法构建抑制性抗病毒方案。该药后来也在加拿大和美国获得了类似适应症的批准。作为首个已知能抑制HIV-1衣壳的获批药物，获得首创药物认定。 HIV-1衣壳是一种包含病毒遗传物质的蛋白壳，被认为与HIV生命周期的多个阶段有关。 该药物可口服、可注射治疗，作为HIV-1低释放、长效治疗，当与抗逆转录病毒药物联合使用时，可能需要每6个月给药一次，目的是提高患者的依从性和药物依从性。 其大批量合成路线涉及多个关键中间体的合成，路线如下： 2.3、Ensitrelvir Fumaric Acid (Xocova) 富马酸Ensitrelvir(3)，也被称为S-217622，是由Shionogi公司开发的非共价口服SARS-CoV-2主蛋白酶（Mpro）抑制剂。该药物已被日本PMDA批准用于治疗由SARS-CoV-2（COVID-19）感染引起的疾病。 该药物对许多最常见的Mpro突变体保持一定的抑制活性，并对多种流行的SARS-CoV-2变种表现出抗病毒活性。Ensitrelvir是第二款被批准用于治疗COVID-19引起的疾病的Mpro抑制剂。 与首个批准的治疗药物Paxlovid不同，Ensitrelvir不需要与CYP3A4抑制剂一起给药来减弱体内代谢此外，Ensitrelvir与其他三种人类感染冠状病毒（MERS-CoV， SARS-CoV和HCoV-NL63）的主要蛋白酶复合物的晶体结构表明该药物具有共价相互作用。 由Shionogi报道的公斤级合成路线如下： 2.4、Contezolid (Youxitai) Contezolid(4)，也被称为MRX-I，是由上海盟科药业开发的口服给药恶唑烷酮抗菌剂。Contezolid克服了结构相似的利奈唑胺的单胺氧化酶（MAO）抑制限制的局限性。 该药物用于治疗多重耐药革兰氏阳性细菌感染引起的复杂皮肤和软组织感染，包括甲氧西林敏感金黄色葡萄球菌（MSSA）、耐甲氧西林金黄色葡萄球菌（MRSA）、化脓性链球菌、无乳链球菌和耐万古霉素肠球菌。 其合成路线如下： 2.5、Oteseconazole (Vivjoa) Oteseconazole(5)获得美国FDA批准，用于治疗有外阴阴道念珠菌病病史，且没有生育潜力的女性复发性外阴阴道念珠菌病。其他侵袭性和机会性感染以及甲真菌病的进一步研究正在进行中。 该药物的抗真菌活性是由于抑制甾醇14-α去甲基化酶。这种细胞色素P450（CYP）酶51（CYP51）参与麦角甾醇的生物合成，麦角甾醇是一种通过维持真菌细胞膜完整性来满足真菌生长所需的成分。它在引起外阴阴道念珠菌病的多种念珠菌之间具有活性。 在结构上，由于使用了四唑基团作为金属结合基，所以其他四唑与母唑衍生的抗真菌药是独特的。与含有咪唑或三唑甲基结合基团的抗真菌药相比，四唑的金属亲和力较低，可以通过减少与人CYP酶血红素铁的相互作用来提高选择性。 其低于克级的合成路线如下： 03 心血管/血液病药物 3.1、Hetrombopag Olamine (Hengqu) Hetrombopag olamine(6)是由江苏恒瑞制药公司开发的非肽类血小板生成素受体（TpoR）激动剂，2021年在中国获批，用于治疗慢性原发性免疫性血小板减少症（ITP）和严重再生贫血的成人患者，这些患者对治疗反应不佳。 该药物与其他TpoR激动剂一样，通过与TpoR起源细胞的跨膜结构域结合，诱导巨核细胞，从而增加血小板的产生。 其公斤级规模合成方法如下： 3.2、Tolvaptan sodium phosphate (Samtasu) Tolvaptansodium diumphosphate(7)，也称为Samtasu和OPC-61815，是一种选择性血管抑制V-2受体的小分子拮抗剂，由大冢制药公司开发。 该药物是通用托伐伐坦（7.13）的前药，改善了水溶性。 该药物于2022年在日本获批，用于口服托伐他坦有困难的患者。该药物抑制肾小管的水重吸收，从而在不消耗电解质的情况下增强水利尿。它有效地治疗心力衰竭患者，并已显示出临床益处，如体重减轻、呼吸困难和其他体征和症状的减少。托伐普坦对早期急性心力衰竭也有效，静脉注射托伐普坦可在早期迅速引起心衰。 其百克级合成方法如下： 3.3、Mavacamten (Camzyos) 马伐卡坦(8)是β-心肌蛋白的小分子调节剂，可减轻肥厚性心肌病（HCM）的过度收缩。肥厚性心肌病是由肌粒蛋白突变引起的单基因心血管疾病，特别是肌球蛋白，可能高达每200人中就有1人被发现。 马伐卡坦通过两种方式影响心肌蛋白：减少肌球蛋白-肌球蛋白过桥形成和抑制心肌肌球蛋白ATP酶。两者都通过调节肌球蛋白功能导致收缩性降低。 该药物是由百时美施贵宝的子公司Myokardia开发的，被美国FDA批准用于治疗有症状的纽约心脏协会（NYHA） ii-iii级阻塞性肥厚性心肌病的成人。 其克级合成路线如下图： 3.4、Mitapivat (Pyrukynd) Mitapivat(9)是由Agios Pharmaceutics开发，在美国和欧盟被批准用于治疗溶血性贫血和丙酮酸激酶缺乏症（PKD），这是一种罕见的与慢性溶血性贫血相关的遗传性疾病。 以往PDK的临床治疗仅限于与短期和长期风险相关的支持性治疗，包括红细胞输注和脾切除术。 该药物是一种首创的红细胞丙酮酸激酶激活剂，在未接受常规红细胞输注的患者中已被证明可增加血红蛋白水平。除了被批准用于治疗PKD外，目前还在临床研究中用于治疗镰状细胞病和地中海贫血。 其收敛、高产率合成路线如下图： 04 中枢神经系统疾病药物 4.1、Ganaxolone (Ztalmy) 加那洛酮（10），首创新药，是一种神经活性甾体γ -氨基丁酸（GABA）受体阳性调节剂，用于治疗与周期蛋白依赖性激酶样物质5（CDKL5）缺乏症（CDD）相关的癫痫患者，年龄≥2岁。 CDKL5缺乏性疾病是一种罕见的神经发育疾病，由CDKL5基因的致病性变异引起，发病率从4万分之一到6万分之一不等。虽然很少见，但它是遗传性癫痫最常见的形式之一。 其工业化合成路线如下图： 4.2、Clazosentan Sodium (Pivlaz) 克唑生坦钠（11）是由Idorsia Pharmaceuticals开发的小分子内皮素（ET）受体选择性拮抗剂。该药物抑制ETA受体，可减少动脉瘤性蛛网膜下腔出血后可能发生的ET-相关脑血管痉挛。 该药物在日本被批准用于预防脑血管痉挛、血管痉挛相关脑梗死和动脉瘤性蛛网膜下腔出血后的脑缺血症状。 其最初是罗氏发现的，Axovan在2022年获得了该药物的全球权利，Axovan在2003年被Actelion收购。2017年6月，从Acetelion制药公司剥离旗下子公司后，Idorsia在全球范围内保留了对唑生坦的使用权力。 其合成路线目前还没有明确披露工艺规模，但已经披露了发现阶段规模的药物和结构类似物的合成路径，如下图： 4.3、Sodium Phenylbutyrate and Taurursodiol (Relyvrio) Relyvrio是一个组合用药，包含两种主要成分（12A:12B,3:1质量比），如下图。 由Amylyx Pharmaceuticals市场化，获批用于治疗肌萎缩性侧索硬化症（ALS），这是一种进行性神经退行性疾病，攻击和杀死控制随意肌的神经细胞。 这种联合用药治疗ALS的作用机制目前尚不清楚。 其中苯基丁酸钠（12A)是一种单一芳香脂肪酸，获批用于治疗神经循环障碍，且可大批量商业获得。 另一种有效成分（12B），这是一种自然产生的胆酸，有各种同义词，包括牛磺酸和牛磺酸去氧胆酸（TUDCA）。虽然人类只含有少量的这种胆汁酸，但已知熊的胆汁酸含量很高。 化合物12B的公斤级合成路线如下图： 4.4、Daridorexant (Quviviq) Daridorexant(13)，是一种口服双羟色胺（OX） 1型和2型受体拮抗剂（DORA）治疗失眠的药物。 OX1和OX2是在大脑中表达的G蛋白偶联受体（GPCR），它们的内源性配体sorexin A和dorexin B通过与OX1和dox 2相互作用促进清醒。 该药物阻断了促进清醒的神经肽的结合，以减少过度活跃的清醒。研究发现，发作性睡病与产生OX1的神经元有关，阻断OX1和OX2可以改善睡眠测量。 其合成路线见下图： 05 炎症/免疫药物 5.1、Tapinarof (Vtama) Tapinarof(14)，也称为GSK2894512，由葛兰素史克发现，并于2020年由Dermavant Sciences （Riovant Sciences的子公司）授权使用。 该药物是一种首创的局部芳烃受体（AhR）激动剂，批准用于治疗成人斑块性银屑病，通过抑制关键促炎细胞因子如IL-17和IL-22而具有药理作用。其也可以一直T细胞扩增和TH17细胞分化，然而，确切的作用机制尚不清楚。 其合成路线如下图： 5.2、Deucravacitinib (Sotykto). Deucravacitinib（15），第一类酪氨酸激酶2（TYK2）抑制剂，批准用于治疗中度至重度斑块性银屑病。 自2013年以来，在12种获批药物中，靶标类提供的JAK1、JAK2、JAK3和Tyk2药物干预治疗多种炎症性疾病的影响不能被夸大。由百时美施贵宝公司（BMS）发现的deucravacitinib(15)，也被称为BMS-986165，是第一个含氘的JAK抑制剂，也是第一个被批准的Tyk2选择性抑制剂（相对JAK1、JAK2、JAK3，超5万倍选择性）。 该药物通过与Tyk2的JH2结构域内的同源口袋结合，实现了高度的选择性，这可能导致与其他可用的JAK抑制剂相比，存在安全性差异。 其吨级合成路线如下图： 5.3、Carotegrast methyl (Carogra) Carogra（16）是一种小分子α4-整合素拮抗剂，由EA Pharma开发用于治疗溃疡性结肠炎。 溃疡性结肠炎是炎症性肠病的一个亚类，在美国和世界各地影响着1 - 200万患者。甲基酯功能被水解成具有生物活性的羧酸，其选择性地抑制α-4整合素与细胞粘附分子的结合，从而防止结肠炎的发生。 该药物首次在日本获批，用于治疗对5-氨基水杨酸反应不足的中度溃疡性结肠炎患者。 其合成路线如下图： 06 代谢药物 6.1、Chiglitazar (Bilessglu) Chiglitazar（17）是一种新型的α,δ和γ过氧化物酶体增殖物激活受体（PPARs）的非噻唑烷二酮泛激动剂，已显示出治疗2型糖尿病的希望。 2型糖尿病影响全球超过3.74亿患者，并且在全球范围内发病率和患病率持续上升。该药物优先调节ANGPTL4和PDK4基因的表达，这两个基因与葡萄糖和脂质代谢有关。 其合成路线如下： 6.2、Dorzagliatin (HuaTangNing) Dorzagliatin（18）由华领医药研发，用于治疗糖尿病肾病（DKD）、1型糖尿病（T1DM）和2型糖尿病（T2DM）。 这种小分子口服葡萄糖激酶激活剂（GKA）于2022年9月在中国首次获批，用于T2DM单药治疗和二甲双胍（一种降糖药）联合治疗的成人患者对于2型糖尿病患者，葡萄糖激酶的表达降低，因此，多扎格汀等药物是一种新型的抗糖尿病治疗方案。 其合成路线如下： 07 肿瘤药物 7.1、Adagrasib (Krazati) Adagrasib(19)是Mirati Therapeutics公司开发的KRASG12C的不可逆共价口服抑制剂，被FDA批准用于治疗伴有KRASG12C突变的局部晚期或转移性非小细胞癌（NSCLC）。 KRAS是所有癌症中最常见的突变癌基因，KRAS是一种G蛋白，在调节多种涉及细胞增殖和死亡的途径中起重要作用。导致KRAS过度激活的突变与许多癌症密切相关。 Adagasib靶向突变KRAS G12蛋白的半胱氨酸残基，并且不影响野生型KRAS，导致癌细胞死亡和肿瘤消退。 其工业化合成路线如下： 7.2、Savolitinib (Orpathys) Savolitinib（20）是间充质上皮转化因子（MET）癌基因的小分子抑制剂，于2021年在中国有条件地批准，用于治疗MET外显子跳跃突变的非小细胞肺癌患者。 这种突变导致MET稳定性和表达增加，从而导致多种下游信号通路的延长，这些信号通路调节关键的细胞功能，包括增殖、分化和细胞存活。MET外显子14突变在大约3-4%的非小细胞肺癌患者中出现。 该药物目前正在研究用于治疗其它形式的癌症，包括乳头状和透明细胞癌、胃癌、和结直肠癌。其由和黄医药与AstraZeneca合作开发。 AstraZeneca披露的克级至公斤级合成路线如下： 7.3、Furmonertinib (Ivesa) Furmonertinib（21）是一种选择性表皮生长因子受体（EGFR）酪氨酸激酶抑制剂（TKI），由Allist制药公司开发，用于治疗EGFR突变阳性的非小细胞癌（NSCLC）。 虽然EGFR TKIs已经推出了多种治疗非小细胞肺癌阳性突变形式的抑制剂，但耐药性的发展是一个挑战。临床最重要的耐药突变是在基因790的苏氨酸向蛋氨酸替代（T790M）。这种突变对第一代和第二代EGFR TKIs耐药，促使Furmonertinib成为第三代治疗TKIs。 2021年该药物在中国获得有条件的批准，用于治疗在EGFR TKI治疗期间或之后发生进展的T790M突变的，局部晚期或转移性NSCLC患者。 其公斤级合成路线如下： 7.4、Lazertinib (Leclaza) Lazertinib（22）是一种口服、中枢神经系统渗透的第三代EGFR-TKI，由Janssen和Yuhan开发。 该药物已被韩国卫生和安全部批准用于治疗既往接受EGFR-TKI治疗的EGFR T790M突变阳性非小细胞肺癌（NSCLC）患者。EGFR-TKIs是突变激活EGFR的NSCLC患者的一线治疗方法。尽管NSCLC肿瘤对第一代和第二代EGFR-TKIs的反应最初有所消退，但由于耐药，大多数患者在9-13个月后发生疾病进展。 EGFR T790M突变占对第一代、第二代EGFR-TKIs耐药的肿瘤的50-60%。Lazartinib已被证明可以不可逆地抑制这种突变，不影响野生型EGFR，促进EGFR T790M阳性肿瘤消退。 其多克级合成路线如下： 7.5、Olutasidenib (Rezlidhia) Olutasidenib(23)，一种异柠檬酸脱氢酶-1（IDH1）抑制剂，用于治疗IDH1易感突变的复发或难治性急性髓性白血病（AML）成人患者。 该药物最初是由Rigel Pharmaceuticals开发的，随后与Forma Therapeutics （Novo Nordisk子公司）达成许可协议，在美国进一步开发、制造和商业化。 由Rigel Pharmaceuticals披露的合成路线如下： 7.6、Olverembatinib Olverembatinib（24）是由亚盛医药开发的可口服、第三代酪氨酸激酶抑制剂（TKI），用于治疗慢性髓性白血病（CML）、急性髓性白血病、急性淋巴细胞白血病（ALL）和实体瘤。 该药物于2021年11月在中国获得首次批准，并被批准用于具有TKI耐药CML-慢性期和加速期的成人，其中包含T315I“看门人”突变。目前的CML治疗主要以TKIs为中心，然而，TKIs治疗的耐药性，通常是通过BCR-ABL1激酶域点突变，仍然是一个挑战。 Olverembatinib通过作为野生型BCR-ABL1激酶和广泛相关的突变体（包括T315I）的ATP结合位点抑制剂，保持其有效性，否则会对第一代和第二代TKIs产生抗性。 其合成路线如下： 7.7、Valemetostat Tosylate (Ezharmia) Valemetostat Tosylate（25）由Daiichi Sankyo公司开发，于2022年9月在日本获批，用于治疗复发或难治性成人细胞白血病-淋巴瘤（R/RATL）患者，这种癌症现有治疗方案很少且预后不良。 该药物是一种口服的选择性双抑制剂，可抑制表观遗传靶点EZH1（zeste同源1增强子）和EZH2 （zeste同源2增强子），它们与多梳抑制复合体2（PRC2）相连接。EZH1/2通过组蛋白甲基化调节基因表达，从而抑制与肿瘤抑制和细胞分化相关的基因。 虽然EZH2选择性抑制剂之前已经开发出来，但EZH1可以补偿EZH2的损失，因此需要开发双抑制剂。与EZH2选择性抑制剂他zemetostat相比，Valemetostat能显著降低组蛋白H3赖氨酸27（H3K27）三甲基化。 其公斤级合成路线如下： 7.8、Fuzuloparib (AiRuiYi; Formerly Fluzoparib) 福唑帕利（26）是一种口服活性聚（ADP-核糖）聚合酶（PARP）抑制剂，由江苏恒瑞开发，被批准用于治疗铂敏感复发性卵巢癌、输卵管癌或原发性腹膜癌患者，这些患者患有生殖系乳腺癌基因（BRCA）突变，接受过二线或以上化疗。 PARP酶在细胞的DNA损伤修复（DDR）反应中起着重要作用，PARP结合DNA损伤位点，并催化PAR化，导致同源重组（HR）募集DNA修复机制。缺乏BRCA的癌细胞修复DNA双链断裂（DSB）的能力有限。 Fuzuloparib显示出强大的抗癌活性，可以抑制BRCA缺陷导致的HR缺陷。该药物抑制正常的PARP功能，使DSB在肿瘤细胞中逐渐积累，最终达到合成致死。由于具有显著的生存益处，一些PARP抑制剂已被FDA、EMA和NMPA批准用于甲状腺、乳腺癌、胰腺癌或前列腺癌患者。 恒瑞披露的大规模合成路线如下： 7.9、Pamiparib (Partruvix) Pamiparib（27）是百济神州开发的口服活性、强效、高选择性PARP1和PARP2抑制剂。该药物于2022年在中国被批准用于治疗BRCA突变的复发性晚期卵巢癌、输卵管癌或原发性腹膜癌。 BRCA11和BRCA2是通过功能同源重组（HR）修复DNA双链断裂（DSB）的关键肿瘤抑制因子。据称该药物对治疗伴有脑转移的癌症患者表现出良好的脑穿透能力。 百济披露了其工业化规模原料药合成路线如下： 7.10、Lutetium (177Lu)Vipivotide Tetraxetan (Pluvicto) Lutetium (177Lu)vipivotide tetraxetan(28)，也被称为177Lu-PSMA-617，是一种放射性药物，于2022年被批准用于治疗前列腺特异性膜抗原（PSMA）阳性的转移性去势抵抗性前列腺癌（mCRPC），并获得FDA认定为首创药物。 该药物部分由普渡大学、海德堡大学医院和德国癌症研究中心的研究人员发现，最初授权给德国制药公司ABX，其早前于2017年被Endocyte收购，随后于2018年被诺华公司收购。 该药物作为FDA批准用于治疗前列腺癌（PCa）的第一种放射性药物，该化合物由于其大分子量而具有较长的清除时间和有限的进入肿瘤的所有部分。 研究人员在研究了一系列基于脲-DOTA偶联PSMA抑制剂，具有最低的药效要求，可以有效结合PSMA，同时改善药代动力学和组织分布，最终开发出了PSMA-617。该分子在与68Ga结合时显示出诊断性，与177Lu结合时显示出治疗性。 由于其分子量、理化性质、和递送目标，该药物具有高度的效价和选择性，同时可进入广泛分布的组织腔室。 其合成路线如下： 7.11、Disitamab vedotin (Aidixi) 迪西他单维多汀（29）是人表皮生长因子受体2（HER2）特异性抗体-药物偶联物（ADC），连接了缬氨酸-瓜氨酸可切割连接物（mc-Val -Cit-PABC）与细胞毒剂（有效载荷）单甲基auristatin E(MMAE)，抗体与连接物-有效载荷单元（mc-Val -Cit-PABC-MMAE, 29.3）的比例为1:4。 该ADC于2021年首次在中国获批用于治疗HER2过表达（定义为免疫组织化学评分为2+/3+）的局部晚期或转移性胃癌（包括胃食管交界处腺癌）患者，这些患者之前至少接受过两次全身化疗。 MMAE是一种以auristatin为基础的微管抑制剂，已知可以诱导细胞凋亡和抑制靶向细胞的有丝分裂，使ADC内化，并从连接子释放细胞内。 该ADC是由RemeGen和Seagen合作开发，双方已签订了开发和商业化的联合许可协议。 其合成路线如下： 7.12、Pimitespib (Jeselhy) Pimitespib（30）已在日本被批准用于治疗化疗后进展的胃肠道间质瘤（GIST）。它的靶标是细胞休克蛋白90 (HSP90)，这是一种分子伴侣，涉及稳定几种负责肿瘤生长的蛋白质。与其他HSP90抑制剂相比，Pimitespib选择性靶向HSP90的α和β亚型，并且具有减少脱靶效应，特别是减少视觉干扰。 Taiho Pharmaceuticals披露的其合成路线如下： 7.13、Donafenib (Zepsun) 多纳菲尼（Donafenib，31）是多激酶抑制剂索拉非尼（sorafenib）的减氢衍生物，用于治疗晚期肝细胞癌（HCC）。 HCC是成年人最常见的原发性肝癌类型，也是全球癌症相关死亡的第三大原因。多纳非尼抑制Srf激酶和VEGFR酪氨酸激酶，从而阻止肿瘤细胞的增殖。该药物中氘代甲基的存在改善了代谢稳定性，半衰期延长，全身清除率降低，全身暴露增加。 该药在中国首次获批永固治疗以前未接受过全身治疗的不可切除的HCC患者。 其克级合成路线如下： 7.14、Futibatinib (Lytgobi) 福替替尼（Futibatinib, 32）用于治疗多种类型的癌症：乳腺癌、胆管癌、胃癌、非小细胞癌、食管癌和尿路上皮癌。口服小分子癌症治疗药物于2022年9月下旬在美国获得FDA加速批准，该药物是一种不可逆抑制剂和选择性共价结合成纤维细胞生长因子受体（FGFR)1-4。 由于FGFR信号通路失调（可由染色体重排、突变、上调和扩增引起）会破坏组织稳态并最终导致癌变，因此抑制该受体是一种很有前景的癌症治疗方法。 Taiho Pharmaceuticals披露了其合成路线如下： 7.15、Pacritinib (Vonjo) Pacritinib（33）是一种联合Janus激酶2（JAK2）和McDonough肉瘤（FMS）样受体酪氨酸激酶3（FLT3）抑制剂，已被批准用于治疗血小板计数低的患者的黄纤维化。 该药物的独特之处在于，它能抑制Jak2和FLT3信号通路的多个成员，并对野生型和突变型Jak2和FLT3细胞系失活。与其他治疗方案（如骨髓纤维化）不同，该药物与骨髓抑制无关，最常见的不良反应是可控制的胃肠道疾病。发现其可以减少贫血和血小板减少症患者的脾肿大和与骨髓纤维化相关的症状。 其合成路线如下： 08 呼吸/肺部药物 8.1、Gefapixant (Lyfnua) Gefapixant(34)，也被称为MK-7264，优先于AF-219和RO-4926219，是一种用于治疗慢性咳嗽的P2×3拮抗剂，最近被日本批准。慢性咳嗽是患者求医问诊和不明确的最常见原因之一，在过去12个月内咳嗽≥8周。成人慢性咳嗽的患病率为5%，并可能与生活质量的恶化有关。 其工业合成路线如下：